TABLE
Older adults are having sex—and experiencing sexual problems
| Activity or problem by gender | Number of respondents | Report, by age group (95% confidence interval*) | ||
|---|---|---|---|---|
| 57–64 yr (%) | 65–74 yr (%) | 75–85 yr (%) | ||
| Sexually active in previous 12 months† | ||||
| Men | 1,385 | 83.7 (77.6–89.8) | 67.0 (62.1–72.0) | 38.5 (33.6–43.5) |
| Women | 1,501 | 61.6 (56.7–66.4) | 39.5 (34.6–44.4) | 16.7 (12.5–21.0) |
| Difficulty with lubrication | ||||
| Women | 495 | 35.9 (29.6–42.2) | 43.2 (34.8–51.5) | 43.6 (27.0–60.2) |
| Pain during intercourse | ||||
| Men | 878 | 3.0 (1.1–4.8) | 3.2 (1.2–5.3) | 1.0 (0–2.5) |
| Women | 506 | 17.8 (13.3–22.2) | 18.6 (10.8–26.3) | 11.8 (4.3–19.4) |
| Avoidance of sex due to sexual problems** | ||||
| Men | 533 | 22.1 (17.3–26.9) | 30.1 (23.2–37.0) | 25.7 (14.9–36.4) |
| Women | 357 | 34.3 (25.0–43.7) | 30.5 (21.5–39.4) | 22.7 (9.4–35.9) |
| Source: Adapted from Lindau ST, et al.6 | ||||
| Adjusted odds ratios are based on a logistic regression including the age group and self-rated health status as covariates, estimated separately for men and women. The confidence interval is based on the inversion of the Wald tests constructed with the use of design-based standard errors. | ||||
| † These data exclude 107 respondents who reported at least one sexual problem. | ||||
| ** This question was asked only of respondents who reported at least one sexual problem. | ||||
Assessing menopause-related sexual function is a challenge
Although the transition phases of menopause have been well studied and reported for decades, few of these studies have included questions about the impact of menopause on sexual function.7 When longitudinal studies that included the classification of female sexual dysfunction began to appear, they provided evidence of the important role that VVA and psychosocial factors play in female sexual dysfunction.8
In the fourth year of the Melbourne Women’s Midlife Health Project longitudinal study, six variables related to sexual function were identified. Three were determinate of sexual function:
- feelings for the partner
- problems related to the partner
- vaginal dryness/dyspareunia.
The other three variables—sexual responsiveness, frequency of sexual activity, and libido—were dependent or outcome variables.
By the sixth year of this study, two variables had increased in significance: vaginal dryness/dyspareunia and partner problems.7
Sexual pain and relationship problems can create a vicious cycle
The interrelationship of vaginal dryness, sexual pain, flagging desire, and psychosocial parameters can produce a vicious cycle. A woman experiencing or anticipating pain may have diminished sexual desire or avoid sex altogether. During intercourse, the brain’s awareness of vaginal pain may trigger a physiologic response that can cause the muscles of the vagina to tighten and lubrication to decrease. The result? Greater vaginal pain.
This vicious cycle can contribute to relationship issues with the sexual partner and harm a woman’s psychosocial well-being. Resentment, anger, and misunderstanding may arise when a couple is dealing with problems of sexual function, and these stressors can damage many aspects of the relationship, further exacerbating sexual difficulties.
An additional and very important dimension of these issues is their potential impact on the family unit.
VVA can diminish overall well-being
In a 2007 survey reported at the North American Menopause Society (NAMS), one third to one half of 506 respondents said that VVA had a bad effect on their sexual interest, mood, self-esteem, and the intimate relationship (FIGURE 1).9 Reports from in-depth interviews were consistent with survey results and offered further insight into a woman’s emotional response to the condition of vaginal dryness and its impact on her life. Women found the condition “embarrassing,” something they had to endure but didn’t talk about, and felt that it had a major impact on their self-esteem and intimate relationship.
FIGURE 1 Dyspareunia affects more than interest in sex—relationships, mood, and self-esteem suffer
Simon JA, Komi J. Vulvovaginal atrophy (VVA) negatively impacts sexual function, psychosocial well-being, and partner relationships. Poster presented at North American Menopause Association Annual Meeting; October 3-6, 2007; Dallas, Texas.
Clinicians often don’t ask about VVA, and patients are reluctant to talk
Among women of all ages, dyspareunia is underreported and undertreated. In the survey reported at NAMS, 40% of respondents said that their physician had never asked them about the problem of VVA (FIGURE 2).9
Women themselves may be reluctant to discuss the problem with physicians, nurse practitioners, or other health-care providers out of embarrassment or the assumption that there is nothing to be done about the problem. Nevertheless, more than 40% of respondents said they would be highly likely to seek treatment for VVA if they had a concern about urogenital complications of the condition (FIGURE 3).9
Another barrier may be the sense that asking the health-care provider about sex may embarrass him or her. As a result, sufferers do not anticipate help from their physician and other members of the health-care profession and fail to seek treatment or counseling for this chronic medical condition.10,11
In a 1999 telephone survey of 500 adults 25 years of age or older, 71% said they thought that their doctor would dismiss concerns about sexual problems, but 85% said they would talk to their physician anyway if they had a problem, even though they might not get treatment.11 In that survey, 91% of married men and 84% of married women rated a satisfying sex life as important to quality of life.11